Third World Britain: Is malnutrition a big problem in the UK?
"One in ten older people are malnourished and 93% of them are in the community." The Daily Star, 9 May 2013
"Third world Britain: 'One in ten' elderly suffer from malnutrition" The Express, 9 May 2013
We have heard in the past that the UK is facing an obesity crisis, but could there also be a malnutrition crisis?
Two newspapers today claimed that a tenth of all older people in the UK are malnourished. Is this true?
What is malnutrition?
The National Institute for Health and Care Excellence (NICE) guidance in Nutrition support in adults defines malnutrition as being characterised by a body mass index of less than 18.5, unintentional weight loss greater than 10% within the last 3—6 months or a BMI of less than 20 AND unintentional weight loss greater than 5% within the last 3 to 6 months.
So are one in 10 older people malnourished?
The Express and the Star source the claim to a research paper jointly put together by the British Dietetic Association and the Malnutrition Task Force.
This actually claims something slightly but importantly different: that 10% of over 65s are malnourished or at risk of malnutrition.
The figure isn't a new one: the Malnutrition Task Force cites a 2006 report published by the European Nutrition for Health Alliance as the source for the claim.
This in turn points to a 2005 research paper: "Geographical inequalities in nutrient status and risk of malnutrition among English people aged 65 years and over." As the title suggests, the research paper focused on the north-south divide among older people living in England "with respect to risk of protein-energy malnutrition and status of nutrients, particularly those derived from fruit and vegetables," using data from the National Diet and Nutrition Survey.
Though we don't have access to the full paper, we know from the synopsis that the study concluded that the risk of "protein-energy malnutrition" varied between 19.4%, 12.3%, and 11.2% for pensioners in the northern, central, and southern regions of England respectively.
What does this mean?
Without access to the full paper, it's difficult to comment upon the paper's findings, although the researcher did highlight his concerns in the press at the time.
However this research doesn't seem to suggest that over 10% of people are malnourished, but rather means that, depending on the region, over 10% of people aged over 65 risk suffering from malnourishment due to an inadequate protein intake. This clearly isn't the same definition of malnourishment used by NICE.
The other unknown is how the risk in elderly people compares to the rest of the population. Again, without knowing further details in the study, we don't know how the researchers have treated this. However looking at the most recent National Diet and Nutrition Survey does suggest that in some respects, such as fruit and vegetable consumption, older people may be eating more healthily than other adults:
"Adults aged 19 to 64 years on average consumed 4.1 portions of fruit and vegetables per day (including the contribution from composite dishes) and older adults (i.e. those aged 65 years and over) 4.4 portions. 31% of adults and 37% of older adults met the "5-a-day" recommendation."
Is this evidence of 'Third World Britain'?
As we've pointed out before, there can be a number of reasons why a person becomes malnourished. As the ONS has said:
"There are many explanations as to why someone becomes malnourished: for example they may have cancer of the digestive tract, which means they can't eat properly or can't absorb nutrients; they may have suffered from a stroke or have advanced dementia which can cause difficulties chewing and swallowing; or they may abuse alcohol and so not eat properly."
Some of these conditions are associated with age, which means there may not simply be the case that a failure in care for older people is always behind cases of malnutrition (although the author of the 2005 study does point to "social isolation, poverty and conditions that might prevent people from getting to food, such as mobility problems, mental health, difficulty in eating and disease" as key factors.)
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